Management of spontaneous and catamenial pneumothorax

Primary (idiopathic) spontaneous pneumothorax frequently occurs in tall healthy young men between 15 and 30 years of age. Conservative treatment by thoracic drainage is proposed for the first episode. In case of recurrence, thoracoscopy with wedge resection of the apex of the upper lobe and pleurodesis is proposed with a recurrence rate between 4 and 6%. Catamenial pneumothorax, which occurs within 48 to 72 hours of the menstrual cycle, is probably often mistaken for primary pneumothorax due to the difficulty in proving thoracic endometriosis. Thoracoscopy is proposed from the outset to search for foci of endometriosis or diaphragmatic fenestrations. In case of recurrence, thoracotomy with pleurectomy and hormonal treatment may be proposed, but with a risk of definitive sterility.